Salvage cytoreductive surgery for recurrent endometrial cancer

Abstract

Objective To determine the survival impact of salvage cytoreductive surgery, and other prognostic variables, among patients with recurrent endometrial cancer. Methods All patients diagnosed with endometrial cancer recurrence between 7/1/97 and 6/30/05 were retrospectively identified from the tumor registry database. Demographic, pathological, and clinical data were abstracted from the medical record. Survival estimates were calculated using the Kaplan and Meier method. Univariate and multivariate regression analyses were used to identify characteristics associated with overall survival from time of recurrence. Results Sixty-one patients were identified with endometrial cancer recurrence a median of 18.5 months after initial diagnosis. Median age at recurrence was 63 years, and the median post-recurrence follow-up time was 22.0 months. Thirty-five patients underwent salvage cytoreductive surgery and had a median survival time of 28.0 months, compared to 13.0 months for patients treated non-surgically ( P < 0.0001). Complete cytoreduction (no gross residual) was achieved in 23/35 surgical patients (65.7%). The median EBL was 350 cc and 28.6% of patients received blood products. There were no peri-operative deaths; however, 31.4% of patients experienced minor morbidity. Patients undergoing complete salvage cytoreduction had a median post-recurrence survival time of 39.0 months, compared to 13.5 months for those patients with gross residual disease ( P = 0.0005). On multivariate analysis, salvage surgery and residual disease status were significant and independent predictors of post-recurrence survival. Conclusions Complete salvage cytoreductive surgery for recurrent endometrial cancer is associated with prolonged post-recurrence survival compared to patients left with any gross residual disease. Additional studies are warranted to define appropriate surgical indications and selection criteria.